Fertility Testing, IVF and Surgery

The causes of infertility in women can often be complex. Your physician may perform multiple fertility tests to determine the exact cause of your infertility. These tests may include:

• Hormone blood tests to check for proper hormone levels and cycles of ovulation
• Pelvic sonograms—also called ultrasounds—are a non-invasive imaging procedure that can reveal the presence of fertility problems such as fibroids
• Hysterosalpingogram (HSG) is also known as a tubal dye test. During a hysterosalpingogram, a thin tube inserted through the vagina distributes dye into the uterus and fallopian tubes. A hysterosalpingogram uses X-ray images to capture the passage of the dye as it passes through the uterus and fallopian tubes. A hysterosalpingogram can reveal any fallopian blockages that could be causing infertility.
• Laparoscopy is used to examine the pelvic organs from the inside via a small camera that is surgically inserted into the abdomen through the navel. Once the camera is in place, the surgeon can check for abnormal growths or adhesions on the uterus, fallopian tubes or ovaries.

The most common type of male fertility testing is semen analysis. During a semen analysis test, your semen will be checked for signs of infertility including low sperm motility, a low sperm count or high acidity of semen. A thorough semen analysis will help your physician determine if there are issues with sperm production or quality.

Other types of male fertility testing are dependent on the result of the semen analysis. Additional types of male fertility testing include:

• Physical examinations
• Hormone testing
• Genetic testing
• Testing for anti-sperm antibodies

The term in vitro fertilization (IVF) means that the egg was fertilized outside of the body. During in vitro fertilization, either your eggs, or donor eggs, are removed and combined with sperm in a laboratory setting. Once your egg (or the donor egg) is fertilized, they are placed back into the uterus where they will hopefully implant for pregnancy.

In some IVF procedures, your egg or the donor egg are combined with sperm in a sterile test tube or chamber. At this point in the in vitro fertilization process, a single sperm will enter the egg for fertilization. Another option for fertilization is intracytoplasmic sperm injection (ICSI), where a single healthy sperm cell is injected directly into your egg or the donor egg.

IVF has some variations to the procedure. Your physician may suggest a variation of in vitro fertilization based on the cause of infertility, the use of a donor egg or the 

These IVF variations include:

If your fertility issues cannot be corrected by fertility medications, your physician may suggest infertility surgery to improve your ability to conceive. For women, infertility surgery can include:

• Hysteroscopy for treatment of fibroids, adhesions, uterine septum, and bicornuate uterus (heart-shaped uterus)
• Fertility-sparing myomectomy to remove uterine fibroids, including robot-assisted surgery 
• Transuterine catheterization of the fallopian tubes (TUCFT), a procedure to clear blocked fallopian tubes
• Tubal reconstruction for collapsed fallopian tubes
• Reversal of a tubal ligation (tied tubes)

As an alternative to open surgery, your physician may suggest laparoscopic endometriosis surgery. Endometriosis is a condition where endometrial cells grow outside the uterus causing pain, irregular bleeding and sometimes infertility. During laparoscopic endometriosis surgery, the surgeon makes small incisions and then inserts a tiny camera and surgical instruments into the body.

The surgeon can then remove the excess endometrial or scar tissue without a large incision. Laparoscopic endometriosis surgery causes less scarring and can reduce recovery time. Robotic-assisted endometriosis surgery is another option to remove excess endometrial tissue.

Endometriosis, previous surgeries and some infections can cause adhesions, where scar tissue forms between two surfaces inside the pelvis and binds them together. Laparoscopic adhesion surgery is a minimally invasive procedure to remove this excess tissue that might be preventing conception. Laparoscopic adhesion surgery can reduce symptoms and in some cases, restore fertility.